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Stay up-to-date on what's new at the Department of Health Care Policy & Financing with our newsletter created specifically for the Colorado General Assembly.
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This newsletter is published monthly while the legislature is in session, and quarterly outside of the legislative session. The next edition will be published in November 2020.
Please continue to direct any questions or constituent issues to the Department of Health Care Policy & Financing (the Department) legislative team:
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Rachel Reiter, HCPF Deputy Director of Policy, Communications & Administration
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Message from Executive Director Kim Bimestefer
As you know, this year's unusual legislative session has come to an end, including the Governor's signature on the Long Bill, which sets the State's budget. I want to thank you for your partnership in adopting the difficult but necessary cuts to HCPF's budget during this unprecedented economic downturn. The impact of COVID-19 is causing an increase in demand for our safety net programs and a concurrent decrease in available state funds -- certainly a difficult reality to navigate. Cuts to the HCPF budget impacted member co-pays, provider reimbursement, some benefits and HCPF administration funding, as well.
Our members will see an increase in co-pays to the federal maximum on pharmacy, physician services, Federally Qualified Health Center visits, Regional Health Center visits, inpatient services, outpatient services, durable medical equipment, lab and x-ray, anesthesia, Non-Emergent Medical Transportation (NEMT) and dental services. Members currently exempt from co-pays will continue to be exempt from co-pays. At the same time, HB 20-1361 reduces the cap for the adult dental benefit from $1,500 to $1,000 per year for each recipient until December 2022. Both changes will be effective upon federal approval, but not before January 2021.
Coloradans need our programs now more than ever. The Department anticipates a net membership surge of 300,000 to 500,000 Coloradans as the downturn causes Coloradans to lose their jobs and their associated employer-sponsored health coverage -- figures that could exceed the membership uptake fueled by the Accountable Care Act.
We also want to thank you for your partnership in communicating our Here For YOU, Colorado! campaign, which is intended to help keep Coloradans covered during this pandemic and economic downturn. We are posting resources like draft emails, newsletter articles, social media posts and ads that you can share with your constituents. Key messages cover Health First Colorado (Colorado's Medicaid program) and Child Health Plan Plus (CHP+) eligibility rules, benefits, how to apply, provider enrollment and more. Please help us spread the word! Visit CO.gov/HCPF/HereForYou for materials and messaging.
Please also help us remind your contacts that the Governor has mandated wearing masks in public. We are pushing that message out on our social channels and hope you'll help share it.
Thank you again for your partnership, and for all you are doing to support and assist Coloradans during this very difficult time.
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We're Here for YOU, Colorado
As many Coloradans struggle with job loss resulting from the coronavirus (COVID-19) pandemic, the Department is here to keep Coloradans covered with health insurance through Health First Colorado and Child Health Plan Plus (CHP+).
It's critical that Coloradans know they can apple for health coverage at any time and it's easy to do. Please help us spread the word. We have created materials for distribution by our many partners to help Coloradans who need health care coverage, and to help us recruit more health care providers to help serve our more than 1.3 million current members and the more than 500,000 new members we expect to enroll by the end of this year. For more information on the anticipated enrollment surge, read the press release. Thank you for helping us ensure all Coloradans have access to health care coverage during this public health emergency and beyond!
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SB20-212 Telemedicine Update
During the abbreviated legislative session, SB20-212 passed making the Department's emergency telemedicine rules permanent. The conforming rules passed unanimously at the Medical Services Board on August 14. As a result, the Department is now assessing the impact of these permanent policies while meeting the goal of increased accessibility while delivering quality care for members and practicing fiscal responsibility. The Department is currently working on:
- Collecting, studying and posting utilization data, per the requirements of SB20-212
- Conducting research and evaluation regarding
- Access to care & utilization
- Health equity
- Quality and member outcomes
- Reimbursement and payment
- Fiscal stewardship, and
- Engaging broadly with providers, members, and advocacy groups to ensure their voices, ideas, and concerns are hear and addressed.
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Electronic Visit Verification (EVV) Update
Electronic Visit Verification (EVV) is an electronic system that verifies home and community-based service visits by documenting six points of data, including: type, date, and location of service; individuals receiving and providing the service; and time the service begins and ends.
On August 3, 2020 the use of EVV became mandated by Colorado Code of Regulation 8.001.
The Department is utilizing a tiered implementation strategy to allow providers time to familiarize themselves with the use of EVV, minimize long-term administrative burden, and reduce financial impact when EVV records are required prior to claim adjudication on January 1, 2021.
August 3, 2020 - Compliance Monitoring:
- Claims submitted to the Department that require EVV records are reviewed for corresponding EVV.
- Providers not using EVV after August 3, 2020, must submit a written plan to the Department outlining their intent to utilize EVV and when compliance is expected.
- During this stage, the Department is looking for a good faith effort from providers not perfection.
October 1, 2020 - Over-Payment Review:
- Claims submitted to the Department that require EVV records are reviewed for corresponding EVV.
- All claims subject to EVV requirements will pay initially, even if no EVV record is on file to match the claim.
- Paid claims that don't have valid matching EVV records may be subject to Department review and recoupment as Over-Payment Recovery.
January 1, 2021 - Pre-Payment Claim Adjudication:
- Claims submitted to the Department that require EVV records must be matched to valid EVV records to pay.
- Due to the unique payment structure for Hospice services, Hospice are exempt from pre-payment claim adjudication. Hospice services are subject to Compliance Monitoring and Over-Payment Recovery only.
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Behavioral Health Task Force Update
HCPF is very grateful to have a seat on the Behavioral Health Task Force and to work so closely with out sister agencies, the Lt. Governor's Office, and the Governor on setting the vision for systemic change in behavioral health.
In the past few weeks, the Main Task Force voted to address system fragmentation by creating a state Behavioral Health Administration. They also voted on a set of concrete recommendations to improve access, accountability, affordability, consumer and local input, our state workforce and whole person care.
The task force will use these recommendations and other learnings from the past year to put out a draft blueprint for public comment during the last few weeks of August, then a finalized version will be presented to the Governor by the end of the month.
Over the next year HCPF will be working closely with CDHS on a formal implementation plan, but there are some things we can start doing now, like aligning on value based payments, leveraging our claims and data technology, and increasing access through telehealth.
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Healthy Communities Transition to the Accountable Care Collaborative
Effective July 1, 2020, the Department transitioned the work of the Healthy Communities Program to the Department's Regional Accountable Entities (RAEs).
Historically, the Healthy Communities program provided outreach to newly enrolled families with children under the age of 21 and pregnant women enrolled in Health First Colorado and CHP+. Moving forward, this outreach will be performed by the RAEs and Managed Care Organizations (MCOs) as it aligns well with their existing work and provides cost savings opportunities.
RAEs will now handle Health First Colorado member questions concerning providers and benefits. County departments of human/social services will answer questions about member application and eligibility status. CHP+ customer service will answer any CHP+ member questions at 1-800-359-1991.
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HCPF Submits New Reports & LRFIs to the General Assembly
Since the last newsletter, the Department submitted new reports and Legislative Requests for Information (LRFIs) to the General Assembly. All can be found on the Legislator Resource Center page.
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Medicaid Snapshot and County-by-County Resources
These County Fact Sheets provide an annual snapshot by fiscal year for Colorado's Medicaid program activity including average annual caseload and top five claim types for each county.
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Legislator Resource Center
The Legislator Resource Center on our website is available to help legislators and legislative staff easily find information. It includes links to reports, fact sheets and overviews of the budget process to help inform legislators.
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Follow HCPF on Social Media
We invite legislators to follow us on social media to stay informed of news and happenings at the Department. You can follow us on Facebook, Twitter and LinkedIn.
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Colorado Department of Health Care Policy & Financing
(303) 866-2993 | 1570 Grant Street, Denver, CO 80203
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